SPHeRE Newsletter July 2015

VOLUME2 ISSUE 2 2015SPHeneRtwoErkPOPULATION HEALTH AND HEALTH SERVICES RESEARCH NETWORK UPDATESPHeRE Director WELCOMECongratulations to Prof Steve Thomas, leadership over the past two years Welcome to the SPHeRE NetworkTrinity College Dublin, who has taken which saw the establishment of the Newsletter. It has been a busy fewover the role of SPHeRE Programme new programme, building on the previ- months for scholars and in this is-Director from Prof Anne Hickey, RCSI ous HRB Scholars programme, and its sue you will find news of SPHeREfrom 1st July 2015. The SPHeRE Pro- successful extension to all higher edu- scholar research, publications,gramme operates a two-year rotating cation institutions in the Republic of awards and life after the PhD. Wedirectorship between TCD, UCC and Ireland. also provide news of upcomingRCSI. events in particular the second We wish Prof Thomas every success in SPHeRE Network Conference whichThe programme are very grateful to the coming two years. will take place on 29th FebruaryProf Anne Hickey for her excellent 2016. The call for abstracts will open on the SPHeRE web-site in early August. @SPHeREprogramme SAVE THE DATE 2nd SPHeRE Network Annual Conference ‘Population health and health ser- vices research in Ireland: current trends and future direction’ MONDAY, FEBRUARY 29TH 2016 in RCSI College Hall, 123, St. Stephen’s Green, DublinProf Steve Thomas (TCD), Prof Nick Black (London School of Hygiene & Tropical CALL FOR ABSTRACTS OPEN Medicine), Prof John Browne (UCC) and Prof Anne Hickey (RCSI), 4TH AUGUST See www.sphereprogramme.ie for details #sphere16

SCHOLAR PUBLICATIONSBrennan A, Jackson A, Horgan M,Bergin CJ, and B. JP. 2015. “Resourceutilisation and cost of ambulatoryHIV care in a regional HIV centre inIreland: a micro-costing study.” BMCHealth Services Research 15(139).Donnelly, N.-A., A. Hickey, A. Burns, At the SPHeRE Network Spring Seminar: Prof Steve Thomas (TCD), Dr Donna TedstoneP. Murphy, and F. Doyle. 2015. “Sys- (HRB) Prof John Browne (UCC), Prof Nick Black (London School of Hygiene & Tropicaltematic Review and Meta-Analysis of Medicine), Prof Anne Hickey (RCSI), Prof Nancy Edwards (University of Ottawa), Profthe Impact of Carer Stress on Subse-quent Institutionalisation of Commu- Bernie Hannigan (Public Health England), and Dr Teresa Maguire (HRB)nity-Dwelling Older People.” PLoSONE 10(6): e0128213. Spring SeminarFleming, A., C. Bradley, S. Cullinan, To do the service no harm: the dangersand S. Byrne. 2015a. “Antibiotic Pre-scribing in Long-Term Care Facilities: of quality assessment Prof Nick BlackA Meta-synthesis of Qualitative Re-search.” Drugs & Aging 32(4): 295- The first SPHeRE Spring Seminar took place on 10th March, with Prof. Nick Black303. of the London School of Hygiene & Tropical Medicine. Prof Black presented \"To do the service no harm: the dangers of quality assessment\". Prof Black was theFleming, A., A. Tonna, S. O’Connor, S. first head of the Health Services Research Unit at the London School of HygieneByrne, and D. Stewart. 2015b. and Tropical Medicine. He was Founding Chair of the UK Health Services Re-“Antimicrobial stewardship activities search Network and editor of the Journal of Health Services Research and Policy.in hospitals in Ireland and the United His main research interests are in quality and appropriateness of healthcare.Kingdom: a comparison of two na- Prof Black chaired the National Advisory Group for Clinical Audit & Enquiriestional surveys.” International Journal which advises the DH and NHS England and serves on several other national ad-of Clinical Pharmacy: 1-6. visory bodies on quality assessment and improvement, playing a leading role in the adoption of patient reported outcome measures. CONGRATULATIONSThe HRB Trials Methodology Re-search Network (HRB-TMRN) andIrish Times ran a national writingcompetition to mark this year's Inter-national Clinical Trials Day.Congratulations to Programme Schol-ar Frank Moriarty (RCSI, 2012) whohas been chosen as the winner of thecompetition for his submission onwhy clinical trials should not be ran-dom acts of research. Welldone Frank! The full article is nowavailable on the Irish Times website. Prof Nick Black speaking at the first SPHeRE Network Spring Seminar

Scholar Snapshots SCHOLAR PUBLICATIONSIntegrated care for frail older people Humphries, N., S. McAleese, A. Matthews, and R. Brugha. 2015. By Lorna Roe, TCD “'Emigration is a matter of self- preservation. The working conditions . integrated care for frail older people . . are killing us slowly': qualitative in- and secondly develops an evidence sights into health professional emigra- base around the current model of tion from Ireland.” Human Resources service delivery in Ireland. for Health 13(1): 35. As part of the latter objectives; I cre- Keogh C, Wallace E, O'Brien KK, Galvin R, Smith SM, Lewis C, et al. Developing ated a sub-sample of frail older peo- an International Register of Clinical Prediction Rules for Use in Primary ple aged 65 years+ using TILDA data. Care: A Descriptive Analysis. Ann of Fam Med. 2014;12(4). Using a probability clustering method, Mc Hugh S, O'Neill C, Browne J, I modelled patterns in service use Kearney PM (2015) Influence of partial public reimbursement on vaccination across the whole system of care (17 coverage in the older population. BMC Public Health services from GP, community and Mellon L, Doyle F, Rohde D, Williams D, hospital care) which identified 4 pro- and H. A. 2015. “Stroke warning cam- paigns: delivering better patient out- files of service use labelled according comes? A systematic review.” Patient Related Outcome Measures 6.Within 25 years, our older population to their conditional probabilities (P) Moriarty, F., K. Bennett, T. Fahey, R.is projected to increase from half a of service use. Kenny, and C. Cahir. 2015. “Longitudi- nal prevalence of potentially inappro-million people today to 1.4 million priate medicines and potential pre- scribing omissions in a cohort of com-people which has major implications The first and second profiles “Non- munity-dwelling older people.” Euro- pean Journal of Clinical Pharmacologyfor the healthcare system. Devising Users” (52%) and “Community- 71(4): 473-82.ways to manage age-associated Oriented Users (26%) rely primarily Murphy, C. M., Kearney, P. M., Shelley, E. B., Fahey, T., Dooley, C., & Kenny, R.chronic and geriatric conditions in the on GP care and the provision of infor- A. (2015). Hypertension prevalence, awareness, treatment and control incommunity or ‘ageing in place’; is a mal care only, but have a low proba- the over 50s in Ireland: evidence from The Irish Longitudinal Study on Ageing.key aim of Irish and European policy. bility of hospital use. The next profile J Public Health (Oxf). “Hospital-Oriented Users” (20%) use O'Flynn, A. M., S. M. McHugh, J. M. Madden, J. M. Harrington, I. J. Perry,Older people rely on their social, psy- hospital services and GP services in- and P. M. Kearney. 2015. “Applying the Ideal Cardiovascular Health Metrics tochological and physical resources to tensively but are unlikely to see a Couples: A Cross-Sectional Study in Primary Care.” Clinical Cardiology 38support everyday living. Frail older Public Health Nurse and extremely (1): 32-38.people experience depletion in these unlikely to receive community sup-resources making them vulnerable to ports. The final profile “Both Commu-hospitalisations and admission to nity and Hospital-Oriented Us-nursing home care. Consequentially, ers” (2%) are highly likely to receive atheir timely access to both health and Public Health Nurse and use hospitalsocial care services is fundamental to services intensively and have a 50/50supporting their ability to live at chance of receiving home help or dayhome. Unfortunately the delivery of care services (the highest across theservices to frail older people is com- groups).pounded by a fragmentation in careand difficulty accessing community This analysis presents evidence forsupports. better understanding the manage-Reform of delivery systems is driven ment of frailty across the whole sys-by an ‘integrated care’ strategy, the tem of care in Ireland and the identifi-aim of which is to better coordinate cation of sub-groups who appear toservices for people who have com- rely heavily on the very patterns ofplex needs and require supports from care we most want to change. Thisnumerous services. Frail people are has important implications for theidentified in the literature as a target design of an integrated care approachgroup for such a strategy. in Ireland for frail older people.My thesis firstly examines the con- (Lorna is in Year 4 of her PhD based in TCD)ceptual and empirical evidence of

How influential is carer stress in long-term care admissions? By Nora Ann Donnelly, RCSIFamily carers are pertinent to the suc- such as stress and burden. Leading to a lief that carer stress could underminecess of community care policies. contention that such psychological the sustainability of homecare and thatTherefore, gerontological researchers morbidity of the carer could increase other factors are probably more im-have given much attention to the psy- the risk of long-term care admission by portant. These findings are built on inchological health effects of caregiving, the care recipient. However, this con- a subsequent study which analyses tention has not been critically exam- healthcare professionals and carer’s ined and so is addressed in the PhD perception of the main factors influ- thesis by HRB Scholar Nora-Ann Don- encing long-term care admissions. This nelly. Firstly, through a systematic re- study offers insights into how staff and view and meta-analysis of the prospec- service factors interplay in long-term tive association between various forms care admissions. Our understanding of of carer stress and subsequent institu- these factors is critical if we are to ad- tionalisation of community-dwelling dress the key policy objective to sup- older people. The meta-analysis found port older people to live in their own that while carer stress has a significant homes for as long as is possible. effect on subsequent institutionalisa- tion of care recipients, the overall (Nora Ann is in Year 3 of her PhD based in RCSI) effect size was negligible. The results suggest a need to re-examine the be-The impact of potentially inappropriate SCHOLAR PUBLICATIONSprescribing in middle-aged and older O'Neill, S. M., A. S. Khashan, L. C. Kenny, P. M. Kearney, P. B.people By Frank Moriarty, RCSI Mortensen, R. A. Greene, E. Ager- bo, N. Uldbjerg, and T. B. Henrik-Prescription of medicines is one of the One objective of my thesis is to com- sen. 2015. “Time to subsequentmost common healthcare interven- pare different PIP screening tools to live birth according to mode oftions. While medicines provide many assess their prediction of adverse out- delivery in the first birth.” BJOG:benefits to patients, there is also the comes for participants in The Irish An International Journal of Ob-potential for harm. This is particularly Longitudinal Study on Ageing. My PhD stetrics & Gynaecology.true in older people, due to physiolog- research also addresses the relation-ical changes in ageing which can in- ship between PIP and the increasing Ohakim, A., L. Mellon, B. Jafar, C.crease sensitivity to medicines. Also, numbers of prescribed medicines over O'Byrne, N. G. McElvaney, L. Cor-there is a high burden of multiple the last 15 years and the economic mican, R. McDonnell, and F.chronic illnesses in both middle-aged impact of a number of the most com- Doyle. 2015. “Smoking, attitudesand older people, which can increase mon forms of PIP in Ireland at the mo- to smoking and provision of smok-the chance of drug-disease and drug- ment. ing cessation advice in two teach-drug interactions. The sub-optimal use ing hospitals in Ireland: do smoke-of medicines in such cases can be clas- (Frank is in Year 4 of his PhD, based in RCSI) free policies matter?” Health Psy-sified as potentially inappropriate pre- chology and Behavioral Medicinescribing (or PIP). 3(1): 142-53.PIP can be determined implicitly Sinnott, C., S. M. Hugh, M. B.based on a clinician’s own judgement Boyce, and C. P. Bradley. 2015.or explicitly through the use of screen- What to give the patient who hasing tools. These specify circumstances everything? A qualitative study ofwhere the use of a particular medicine prescribing for multimorbidity inmay be inappropriate. PIP determined primary care.by such tools has been shown to beassociated with adverse outcomes forpatients.

Alumni Focus CONGRATULATIONSDr. Sheena McHugh, UCC Congratulations to Programme Scholar Dr Emma Wallace (RCSI, plinary Capacity Enhancement Award. 2011) for winning not one, but two The ICE Award is a post-doctoral train- awards related to her work on the ing scheme, similar to the SPHeRE pro- impact of clinical prediction rules, a gramme for PhD students. The focus of topic related to but separate from our three year project was to maxim- her PhD area at the Association of ise the use of existing datasets to ex- University Departments of General amine the impact of lifestyle over the Practice in Ireland (AUDGPI) 2015 life course. I had the opportunity to Conference which was held in Bel- work on collaborative research pro- fast in March. jects in TILDA, RAND Europe and the University of Auckland. Emma was awarded the James McCormack prize for Best ResearchI was one of the first students on the This year I was awarded a three year Presentation for her paper onHRB PhD Scholars Programme, now fellowship from CARDI, the Centre for ‘Clinical prediction rules relevant toknown as SPHeRE. I was and luckily Ageing Research and Development in primary care that have gonestill am based at the Department of Ireland. The aim of the project is to through impact analysis'. EmmaEpidemiology & Public Health in UCC. develop a falls prevention intervention also won an academic bursary forAt present I am working as a Research for older people with diabetes. It will ‘Best overall research’.Fellow on the HRB Research Leader be my first experience as Principle In-Award awarded to Prof Patricia vestigator, but like all of the other pro- Dr. Emma Wallace (RCSI 2011)Kearney. The programme of research jects I have worked on to date I will beconcentrates on a population ap- advised and supported by a team of Congratulations also to Pro-proach to prevention and disease con- experts including Prof Patricia grammme Alumnus Sinéad O'Neilltrol for people with diabetes. I am re- Kearney, Dr Suzanne Timmons and Spillane (UCC), who was awarded asponsible for the evaluation of the Na- Prof John Browne. The CARDI Fellow- two-year Cochrane Fellowship fromtional Clinical Care Programme for Dia- ship emphasizes the importance of the HRB to undertake a full Cochranebetes while also contributing to stud- continuing opportunities for career Review on “Different insulin typesies on the prevalence of diabetes and progression and as a result I will take and regimens for pregnant womenits complications, and the quality of up a three year lecturer position in with pre-existing diabetes” with thedisease management. UCC on completion of the research Cochrane Pregnancy and Childbirth fellowship. This is a unique and very Group.I joined the PhD programme with a welcome career path for early and middegree in Psychology from UCD and an -career researchers. Congratulations to the followingMSc in Health Psychology. The struc- scholars who have recently passedtured programme allowed me to sam- The structured PhD programme intro- their Viva:ple different disciplines and methodol- duced me to new concepts and meth- Niamh O'Rourke (RCSI, 2008)ogies. Under the supervision of Prof. odologies, some of which I now have Eithne Sexton (RCSI, 2010)Ruairí Brugha I conducted a policy skills in and others which I have an ap- Aoife McNamara (TCD, 2010)analysis of the Expert Advisory Group preciation for, enabling me to work in Padhraig Ryan (TCD, 2010)for Diabetes and was guided through a multidisciplinary environment.qualitative research in general practice Moreover, the programme has intro-by Prof. Colin Bradley in UCC. I also duced me to an invaluable network ofcarried out an analysis of the quality friends and colleagues with a range ofand organisation of diabetes care un- expertise. These are not only the peo-der the primary supervision of Prof. ple I have worked with on grants andIvan Perry. I graduated in 2012 and publications, but also the ones I havetook up a post-doctoral position in the asked questions of, sought career ad-department conducting an evaluation vice from and sat beside at conferenceof the national breast cancer screening dinners. This is the real strength of theprogramme commissioned by the De- SPHeRE network.partment of Health.In November 2012, I began working on (Dr. Sheena McHugh is a HRB Scholar Alumnia project funded by the HRB Interdisci- from University College Cork. The Programme wishes her every success in her new post )

At the SPHeRE Spring SeminarPictured (l-r) is Prof Cathal Kelly, RCSI; Prof Davinder Sandhu, RCSI Pictured (l-r) is Dr. Claire Collins (ICGP), Dr. Bridget Kane, Dr. SaraBahrain and Prof John Hyland, RCSI Burke (TCD), Laura Murphy (TCD) and Mr. Rory McLaughlinUpcoming EventsEuropean Forum for Primary Care 2015 Conference \"Integrated Primary Care: Research, Policy & Practice\" 30 August - 1September 2015, Amsterdam, The Netherlands59th Annual Scientific Meeting of the Society for Social Medicine 2-4 September 2015 University College Dublin1st Clinical Trial Methodology Symposium, 24-25 September 2015, Gibson Hotel, Dublin2015 IPH Open Conference 13 October 2015, Croke Park, Dublin8th European Public Health Conference \"Health in Europe – from global to local policies, methods and practices\" 14-17October 2015, Milan, ItalyWorld Obesity Federation, Hot Topic Conference: Obesity and Pregnancy, 29- 30 October 2015, London, UKInternational Society for Pharmacoeconomics and Outcomes Research (IPSOR) 18th Annual European Congress\"Impacting Health Decision Making With Outcomes Research: Closing the Gap\". 7-11 Nov 2015 Milan, Italy2015 Annual Scientific Meeting of the UK Society for Behavioural Medicine ‘Biology, Behaviour & Environment’ 8-9 De-cember 2015, Newcastle upon Tyne, UKGrowing Up in Ireland 7th Annual Research Conference 3 December 2015, Dublin Castle STAY IN TOUCH!If you’d like more information about the SPHeRE Network or would like to contribute to our next newsletter, please emailMargaret Curtin ([email protected])For all the latest updates, follow us on Twitter @SPHeREprogrammeor visit our website for more information : www.sphereprogramme.ieThe Health Research Board (HRB) supports excellent research that improves people’s health, patient care and health service delivery. We aim toensure that new knowledge is created and then used in policy and practice. In doing so, we support health system innovation and create new enter-prise opportunities.